Clinic investigation of involved-field irradiation in three-dimensional conformal radiation for old patients of advanced NSCLC

Objective: To evaluate the efficacy and the side effects between involved-field irradiation(IFI) and elective node irradiation (ENI) in old patients of advanced non-small cell lung cancer (NSCLC). Methods: 64 old patients with advanced NSCLC were randomized into IFI group (only irradiated primary tumor and > 1 cm lymph nodes) and ENI group (including primary tumor, ipsilateral hilar, mediastinum draining lymphatic areas of upper and lower carina, upper clavivle draining lymphatic areas when lymph nodes metastasis in upper mediastinum), two groups were both irradiated by 60-64Gy/30-32F. The short-time curative effect and the side effect were compared. Results: In IFI group and ENI group, the CR and the overall response(CR + PR) rates were no significance, P>0.05. The relapse rate between two groups were no significance, P>0.05. Radiation induced pneumonitis occurred 31.2% of patients in IFI and 43.8% in ENI, the difference were significant, P<0.05. Bone marrow depression and heart damage were lower in IFI group than in ENI group, but there were no significance. Radiation esophagitis incidence were lower in IFI than in the ENI group, it was statistically significant, P<0.05. Conclusion: IFI for the old patients of advanced NSCLC is well tolerated. The overall response rate is not higher than in ENI. But the radiation induced pneumonitis is lower in IFI than in ENI, that improve the survival. (authors)